APPLICATION FOR EMPANELMENT IN THE PANEL OF AUDITORS FOR COOPERATIVE

SOCIETIES
Name of the applicant and other details

Individual surname middle name first name Membership

/Propritership No.

In English

In Marathi

Name of the
partnership firm

surname middle name first name Membership

No.

Name of partners of
partnership firm

Name of signing
partner

Firm Registration
No. & date ( if
registered)

Address

Registered office /
office

Building, floor No. Road / Street near / opposite city

Taluka District Pin No.

Contact No.s

Phone No. Phone No. Phone No. Mobile No, Mobile No,

Experience details

Name of the Coop Peirod of audit Year of Audit date of

societies audited From to submission of
audit report

1)

2)

3)

4)

5)

If experince in Cooperative Audit is more than 10 years in case of Chartered Accountant or Firm of Chartered
Accountant and more than 15 years in case of Certified Auditor, give details and attach separate sheet.
 Educational details

Details of year of passing & class secured

educational name of the
qualification University

C.A. ACA FCA

B. Com

M. Com

other graduation
( pl. specify)

other
postgraduation
( Pl. specify)
G. D. C. & A.
Name of partners
of partnership firm

H. D. C. /D.C.B.M

Knolwdge of
Marathi
Language/SSC/HS
C

Declaration

I hereby declare that, the information given above is true and correct

Name of the
person signing the
application

Signuture with
date

if Any authority has

been given for
signing specify it.
Document Graduation Postgraduation G. D. C. & A. S.S.C. passing
certificate certificate certificate certificate for
s attached
marathi
language
(please mark
 wherever
applicable as
)
Individual Membership No.
/Propritershi

H. D. C. certificate / Coopertive audit CAS certificate

D.C.B.M. Certificate Certificate issued by
WIRC

Additional
Qualification
if any

Please read carefully instructions for filling the application , incomplete

applications will be summarily rejected without assigning any reason.

FOR OFFICE USE ONLY

Certified that, the Commitee has verified the details of application filled in, and satisfied that,
he/she/firm should be enrolled in panel, in category A /B /C

District District Special Representative of Member

Deputy Auditor WIRC Certified
Registrar Auditor

Member of Committee